Confronting structural racism in the prevention and control of tuberculosis in the United States.

Tuberculosis incidence in the United States is declining, yet projections indicate that we will not eliminate tuberculosis in the 21 st century. Incidence rates in regions serving the rural and urban poor, including recent immigrants, are well above the national average. People experiencing incarceration and homelessness represent additional key populations. Better engagement of marginalized populations will not succeed without first addressing the structural racism that fuels continued transmission. Examples include: (1) systematic underfunding of contact tracing in health departments serving regions where Black, Indigenous, and People of Color (BIPOC) live; (2) poor access to affordable care in state governments that refuse to expand insurance coverage to low-income workers through the Affordable Care Act; (3) disproportionate incarceration of BIPOC into crowded prisons with low tuberculosis screening rates; and (4) fear-mongering among immigrants that discourages them from accessing preventive health services. To eliminate tuberculosis, we must first eliminate racist policies that limit essential health services in vulnerable communities.